Correlation of VHI-10 to Voice Laboratory Measurements Across Five Common Voice Disorders

ObjectiveTo correlate change in Voice Handicap Index (VHI)-10 scores with corresponding voice laboratory measures across five voice disorders.Study DesignRetrospective study.MethodsOne hundred fifty patients aged >18 years with primary diagnosis of vocal fold lesions, primary muscle tension dysphonia-1, atrophy, unilateral vocal fold paralysis (UVFP), and scar. For each group, participants with the largest change in VHI-10 between two periods (T_A and T_B) were selected. The dates of the VHI-10 values were linked to corresponding acoustic/aerodynamic and audio-perceptual measures. Change in voice laboratory values were analyzed for correlation with each other and with VHI-10.ResultsVHI-10 scores were greater for patients with UVFP than other disorders. The only disorder-specific correlation between voice laboratory measure and VHI-10 was average phonatory airflow in speech for patients with UVFP. Average airflow in repeated phonemes was strongly correlated with average airflow in speech (r = 0.75). Acoustic measures did not significantly change between time points.ConclusionsThe lack of correlations between the VHI-10 change scores and voice laboratory measures may be due to differing constructs of each measure; namely, handicap versus physiological function. Presuming corroboration between these measures may be faulty. Average airflow in speech may be the most ecologically valid measure for patients with UVFP. Although aerodynamic measures changed between the time points, acoustic measures did not. Correlations to VHI-10 and change between time points may be found with other acoustic measures.     

Acoustic Prediction of Voice Type in Women with Functional Dysphonia

The categorization of voice into quality type (ie, normal, breathy, hoarse, rough) is often a traditional part of the voice diagnostic. The goal of this study was to assess the contributions of various time and spectral-based acoustic measures to the categorization of voice type for a diverse sample of voices collected from both functionally dysphonic (breathy, hoarse, and rough) (n=83) and normal women (n=51). Before acoustic analyses, 12 judges rated all voice samples for voice quality type. Discriminant analysis, using the modal rating of voice type as the dependent variable, produced a 5-variable model (comprising time and spectral-based measures) that correctly classified voice type with 79.9% accuracy (74.6% classification accuracy on cross-validation). Voice type classification was achieved based on two significant discriminant functions, interpreted as reflecting measures related to "Phonatory Instability" and "F(0) Characteristics." A cepstrum-based measure (CPP/EXP ratio) consistently emerged as a significant factor in predicting voice type; however, variables such as shimmer (RMS dB) and a measure of low- vs. high-frequency spectral energy (the Discrete Fourier Transformation ratio) also added substantially to the accurate profiling and prediction of voice type. The results are interpreted and discussed with respect to the key acoustic characteristics that contributed to the identification of specific voice types, and the value of identifying a subset of time and spectral-based acoustic measures that appear sensitive to a perceptually diverse set of dysphonic voices.     

The Voice Handicap Index: Correlation Between Subjective Patient Response and Quantitative Assessment of Voice

The aim of this prospective study is to elucidate the relationship between the Voice Handicap Index (VHI) and several voice laboratory measurements in the network of the multidimensional voice assessment. Fifty-eight patients were included. Each patient replies to the questionnaire and performs a voice assessment during the same time. The following parameters were measured: minimum frequency, maximum frequency, range, minimum intensity, subglottic pressure, mean flow, maximum phonation time, jitter, and dysphonia severity index. Regarding the relationship with the scores of the VHI, poor correlations with the minimal frequency for all the scores except the emotional one (total and subscales) and with the range for only the physical one are found. Seventeen questions correlate with the voice laboratory measurements we performed, with a decreased distribution between physical, functional, and emotional subscales. We observe that acoustic parameter is correlated with the emotional subscale, the parameters of the profile range are more often involved in the emotional subscale, as is the minimal frequency, but never with the physical subscale, and all the subscales are interesting despite the smaller number of differences with the emotional one. The VHI and the laboratory measurements give independent informations in practice.     

Common Practices of Voice Therapists in the Evaluation of Patients

This study surveys voice therapists regarding common diagnostic practices in patients referred for therapy with the diagnosis of muscle tension dysphonia (broadly defined as the "hyperfunctional" component of the dysphonia). Through postings on the e-mail list of the ASHA special interest division on voice, speech pathologists with at least 3 years' experience in stroboscopy and acoustic instrumentation were invited to complete the survey. Results from 53 completed surveys demonstrated that voice quality and patient self-perception are the sole assessments performed by all therapists. Voice quality, observation of body posture and movement, and probing the patient's ability to alter voice production are each significantly more likely to be performed than the more objective stroboscopic, acoustic, aerodynamic, and EGG assessments. Further, the tasks of defining specific therapy session goals and helping the patient to achieve a particular target skill are considered best served by measures of vocal quality, observation of body position and movement, and judging the patient's ability to alter voice production. For definition of the overall therapy goal, stroboscopy and patient perception scales are added to all of the subjective assessment measures as being important. Acoustic data are considered most important for patient reinforcement and outcomes assessment. Implications of these findings are discussed, and topics for further exploration are identified.     

Acoustic Interpretation of Resonant Voice

Resonant voice, often described in terms of vibratory sensations in the face, is investigated acoustically by calculating vocal tract inertance. It appears that the ease of production and vibrancy of resonant voice depends more on lowering phonation threshold pressure than on tissue or air resonance in or around the face. Phonation threshold pressure is lowered by increasing air column inertance in the laryngeal vestibule. The fact that the sensations are felt in the face is an indication of effective conversion of aerodynamic energy to acoustic energy, rather than sound resonation in the sinuses or the nasal airways.     

Aerodynamic and Acoustic Characteristics of Voice in Prader-Willi Syndrome

Prader-Willi syndrome (PWS) is a multisystem disorder caused by DNA abnormalities involving chromosome 15. Major characteristics are infant hypotonia, hypogonadism, mental retardation, a short stature, atypical facial appearance, and the onset of obesity due to insatiable hunger in early childhood. Also, speech and language abnormalities have been reported including voice disorders. These have seldom been studied in detail, however. This paper reports the results of an acoustic and aerodynamic investigation of the voice in 22 individuals with PWS. Two age groups were distinguished, a group of children [chronological age (CA) 6 years, 7 months through 11 years, 7 months; total intelligence quotient (TIQ) 40-88] and a group of adolescents and adults (CA 17 years, 1 month through 29 years, 5 months; TIQ 41-94). Both aerodynamic and acoustic parameters were obtained and compared with normative data from the Belgian Study Group on Voice Disorders. It was found that voice difficulties do commonly occur in individuals with PWS including impairment of frequency levels, voice quality, and poor aerodynamic capabilities.     

Objective Voice Analysis for Dysphonic Patients: A Multiparametric Protocol Including Acoustic and Aerodynamic Measurements

The purpose was to determine the clinical value of a multiparametric objective voice evaluation protocol including acoustic and aerodynamic parameters measured mainly on a sustained /a/. This was done by comparison with perceptual analysis of continuous speech by a jury composed of 6 experienced listeners. Voice samples (continuous speech) from 63 male patients with dysphonia and 21 control subjects with normal voices were recorded and assesed by a jury of listeners. The jury was instructed to classify voice samples according to the G (overall dysphonia) component of the GRBAS score on a 4-point scale ranging from 0 for normal to 3 for severe dysphonia. Objective parameters were recorded on an EVA^® workstation. As usual with this type of system, parameters were measured mainly on a sustained /a/. Measured parameters included fundamental frequency (F₀), intensity, jitter, shimmer, signal-to-noise ratio, Lyapunov coefficient (LC), oral airflow (OAF), maximum phonatory time (MPT), and vocal range (range). Estimated subglottic pressure (ESGP) was determined on a series of /pa/. Discriminant analysis was performed to detect correlation between jury classification and combinations of parameters. Results showed that a nonlinear combination of only six parameters (range, LC, ESGP, MPT, signal-to-noise ratio, and F₀) allowed 86% concordance with jury classification. Discussion deals with the relative importance of the different objective parameters for discriminant analysis. Special emphasis is placed on two measurements rarely made in routine clinical workup, i.e., estimated subglottic pressure and Lyapunov coefficient.     

Acoustic Analysis of Voice Quality with or without False Vocal Fold Displacement After Cordectomy

Conventional cordectomy by means of a laryngofissure is one of the therapeutic options for treatment of early glottic cancer. To improve the poor voice quality related to this kind of operation, many authors have developed different techniques to repair the mucosal defect. We analyzed voice quality acoustically and compared it after cordectomy alone and after cordectomy with the reconstruction of the vocal cord in a group of 14 patients affected by T1 glottic carcinoma. All the patients underwent postoperative speech therapy. Three patients who underwent cordectomy with reconstruction showed the presence of diplophonia, while two patients without reconstruction showed the presence of bitonality. The differences of the acoustic parameters (jitter, shimmer, harmonic-to-noise ratio) between the two groups of patients were not statistically significant. Reconstruction of the vocal cord does not seem to improve voice quality after cordectomy even in combination with postoperative speech therapy.